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30 Cards in this Set
- Front
- Back
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What is pneumonia?
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Inflammation of lung due to microorganims
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What cause pneumonia
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Aspiration - material from mouth and stomach enter trachea and into lung
Inhalation of microbes Hematogenous spread primary infection to else where in the body |
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What is the cause of Aspiration P
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Material obstruction - decrease consciousness and endotracheal intubution and general debility
Chemical injury - low pH Bacteral infection - aerobe and anaerobe |
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What are the types of Pneumonia?
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1. CAP - first 2 day of hospitalization
2. HAP - within 48 hrs of admin or longer - VAP - 48 hrs use endotracheal intubution - HCAP - stay in hospital for 2 or more day/ IV antibiotic, chemotherapy... * MRD treatment for HCAP 3. Aspiration P = material from stomach and mouth enter lung * cause: mechanical obstruction, chemical injury, bacterial infection 4. Opportunistic P = alter immune response |
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Who are at risk with Opportunistic P?
What cause it? What is the s/s? |
1. Severe protien calorie malnutrition; Immune deficiency; Chemotherapy and radiation treatment; prolong corticosteroid therapy
2. Bacteria; viral; PCP; cytomegalovirus; Fungi 3. Fever, tachypnea, tachycardia, dyspnea, nonproductive cough, hypoxemia |
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Pathophysiology?
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Congestion
Red hepatization Gray hepatization Resolution |
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Acute onset s/s?
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Fever/ shaking
Cough w/ purulent ( rust color) Shortness of breath Pleuritic chest pain Confusion (Elder) |
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Physical Exam?
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dullness
decrease fremitus bronchial sound crackles |
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Atypical s/s?
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gradual onset
dry cough crackles extrapulmonary |
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Complication?
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pleurisy
pleural effusion bacterermia atalectasis lung abscess pericarditis empyema meningitis endocarditis |
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Diagnostic test?
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X-Ray
Gram stain of sputum/ sputum culture and sensitivity Pulse oximetery and ABG CBC, differential, chemistries Blood culture: Arterial blood gas: hypoxemia, hypercapnia, acidosis leukocytosis |
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Collaboration?
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Antibiotic therapy
Oxygen - hypoxemia Analgesis - chest pain Antiplyretic Fluid intake 3 L Calorie intake 1500/ day Vaccine |
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Implementation for Pneunomia?
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Teach pt nutrition, hygiene, rest and exercise
treat URI Get vaccine Repositon every 2 hours Elevate 30-40 degree prevent aspiration in consciousness and endotracheal intubution user |
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What is Tuberculosis?
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Infection of Mycobacterium Tubercolusis
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Who often get TB?
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Homeless
IV inject drug user Residual inner city neighborhood access poor health care poverty level in institution Older adult |
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What contribution to TB?
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HIV patient
MRD strain MT (resistant to INH & rifampin) |
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Where does TB affect?
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Lung, larynx, kidney, adrenal gland, bones, meninges, lymph node
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What type of MT?
How does it spread? How does it infection pplz? Where does it effect? |
TB: Gram negative; acid fast bacillus
Spread: airborne Infection: Frequent, prolong exposure (6 in from mouth); thru sneezing, coughing and speaking Effect: enter bronchial system implant in bronchial and alveoli |
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Early stage of TB s/s?
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fatigue
malasie anorexia weight loss night sweat low fever |
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Acute stage of TB s/s?
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Chill
High fever pleuritic pain productive cough |
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Classes of TB?
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Class 0 - no TB
Class 1 - exposure to TB Class 2 - LTBI Class 3 - TB; no clinical Class 4 - suspect TB |
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Complication of TB?
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Miliary TB - Invase bloodstream
Pleural effusion - bacteria infection; imflammatory rxn w pleure exudate in protein rich fluid Epyemia TB pneumonia - bacteria form granuloma discharge into lung or lymph node Other organ involvement: CNS - Inflammation of meninges; kidney, adrenal gland, lymph node, bone, joints |
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What are the Diagnostic test for TB?
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1. TST - sensitivity for life
2. X-ray: upper lobe infiltration, cavity infiltration or lymph node involved 3. Bacteriologic study: stain spetum snear exame for acid fast bacilli 4 QuantiFERON - blood culture produce lymphocyte |
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What are the 4 drug therapy for TB?
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Isonizid (INH)
Rifampin Pyrazinimide ethambutol |
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What happen if patient can take rifampin?
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Rifapintine or rifabutin
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How long does a patient to take INH?
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6-9 months
9 month for HIV |
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How long does HIV need to take INH?
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9 months
INH W/ RAFAPENTINE = 1 weekly INH w/ Rifampin or Rifabutin (CD4 lower than 100ul) = 2x weekly |
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What is DOT?
COMBINATION? |
DOT - watch pt swallow medication
Combination: use when DOT not use INH + rifampin = rifamate INH + rifampin + pyzinamide = rifater * nonvial hepatitis = MONITOR LIVER FUNCTION monthly if baseline is abnormal |
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What is the vaccine for TB?
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Bacille Calmatte Guerin (BCG) - use only in other country
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Collaboration for TB acute ?
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Isolation
medical workup drug therapy |
